The Whole Package

Inspirational teaching and progressive research go hand in hand for 2022 Endodontic Educator Fellow Dr. Frederico Canato Martinho

On a typical day, University of Maryland School of Dentistry (UMD) pre-doctoral endodontics director Dr. Frederico Canato Martinho’s schedule has him scurrying between various combinations of clinics with dental students and graduate residents; research; lecturing in graduate and undergraduate courses; and simulation labs.  Also charged with re-establishing Maryland’s endodontic research lab when a prior faculty member retired, he conducts his own studies in the microbiology of endodontic infections, inflammatory mediators and correlated patient symptoms, with the goal of securing future NIH support.  

Moreover, Martinho’s interest in clinical technology helped develop a national reputation for the program in this area while adopting a student-centered perspective on the research component of their training that synchs with the brief timelines of their education compared to clinical evidence research which can go on for many years. 

“He’s one of the hardest people in the school to find sometimes,” says UMD second-year endodontic resident and Foundation REACH resident advisory council member Corey Rollor. “He’s always on the go.”  

Of course, the days don’t end when it’s time to go home.   

“Nights are work, weekends work, that’s how I do it,” Martinho says.  “Weekends I’m getting lectures ready, writing a paper or a grant…during the week, after work I go the gym and work some more… 

“So it’s been like 24/7, but I’m doing what I love…” 

What Martinho loves with a passion and youthful Latin flair is inspiring a respect for endodontics among nascent dentists.  He is universally heralded for a positive, encouraging, mentoring approach to education, and appreciated and admired for his compassion and high standards. Incorporating his own scientific background and research interests, he has created opportunities for students to participate in meaningful research which helps shape their view of how they will practice in the future. 

“Fred is the whole package,” asserts Dr. Patricia Tordik, UMD director of endodontics. “He really can do it all. He’s very hands on involved with the D2s. He runs their first intro to endo.  You make it or break it.  If they don’t like the class when they’re introduced to it early on, that’s it, they’ll probably avoid endo in school and then beyond when they graduate.  First impressions are important.” 

In the big picture, Martinho’s role is far more impactful than instructing a rudimentary knowledge of endodontic procedures among new general practitioners. He focuses both on engaging undergraduate students and giving them a healthy perspective on their limits relative to the training of endodontic specialists. 

“The important part is having the foundational knowledge to know how to refer and when, which helps them to treat patients who need a simple RCT, but also guides them to understand why they need to refer some patients when they don’t have the equipment or skill set needed to deliver certain types of care,” Tordik says.    

“I show them a case where a treatment failed and is being referred to post-grads,” Martinho explains.  “I don’t just stop there because it’s being referred out. If you leave it to just what’s at their level, that’s not engaging. Other specialties like implant dentistry are showing them how to place an implant.  We need to show them our next level too…”

Meanwhile, Martinho acknowledges that “when I started as a predoc director I had a feeling they always wanted to do any case just to meet their requirements… but they were never looking at the complexity of the case.”  He responded by instituting a requirement to complete the AAE case assessment questionnaire to triage each treatment plan.   

“Since we introduced the app to the predoc students, I’ve seen them not try to push to do cases for which they are not prepared.  I think if we train them in the app they will follow the app in the future as a GP. Sometimes dental students who graduated have an endo case in their practice and they contact me to talk about it…so it sounds like it’s working…” 

“The pre-doc director of education is really critical from that perspective,” Tordik says.  [The role is] “not just how do you have a successful site visit every seven years from the ADA or what are the requirements for them to graduate? It’s not really about that.  It’s about how you want them to practice once they have their degree.  If some of them become interested in endo along the way you can really nurture that…    

“The bigger role is so that the GP has a good understanding of what endos do, and can do, to help them make the right treatment decisions for their patients. They’re the gate keepers… you’re not going to get referrals unless they have an understanding… if they’re more comfortable with implants and prosthodontics then that’s what they’re going to recommend to their patients. 

“We only have a small amount of time to make a good impression.  So Fred has a lot of responsibility.  In my opinion the most important position in the endo division or even in any endo dept in any school is the pre-doc director. Those are the ones who have the greatest potential to make the greatest impact.”

Martinho’s students universally agree he is a true teacher who doesn’t simply broadcast knowledge but fosters learning itself, both in the moment and for a lifetime.  He is widely known for embodying a positive approach to professional training and all that it means to wear the mantle of being an educator. 

“He really wanted us to learn—to focus on the big take home messages of how do I incorporate this in everything I’ve learned and on our hand skills, and what to pay attention to every single time in a systematic way, rather than on the grades and how am I going to ace this exam…?” says UMD dental 2025 class president Keon Manesh.  “It really was a phenomenal class…” 

Working with Martinho on studies of the GentleWave device, UMD third-year endodontic resident Tanvir Singh explains “we’re doing a lot of bacterial samples before and after the different access designs. During treatments, I started to think more about the concentration of bacteria that could be present, and how doing different access designs could impact my ability to clean out the bacterial load.   Translating the research to clinical practice has helped me think like a bacterium along every step … not just about having a few steps in a procedure that I’m following…” 

Martinho’s positivity and patient, unfailing encouragement inspires confidence when his students need it most.  

“Sometimes all you need is a little positivity when you’re lacking confidence or feel like you don’t get it,” Manesh says. “Having that support from your mentors and instructors can take you to a whole new level….” 

“I remember telling him one time, ‘this lab is a hot mess because we all don’t know what we’re doing …!’” said UMD D3 Brianna Abraham.  

“‘No, this happens every year, Brianna, he said, everyone knows by the end of the semester how to do a good root canal.  It’s just the process but you will figure it out as you go.’  He’s very reassuring of the teaching process… If something went wrong during a practical like suction or a light wasn’t working, he didn’t freak us out even more by saying you have to hurry it up… he was so calm about it, just move to another chair That’s really how he talks…so sweet and calming and fair.  He understood that life’s not perfect, equipment’s not perfect, things are going to happen, and we’re just going to deal with it as it comes.”   

That same positive encouragement extends to the example he sets as a role model for residents in how they interact with dental students in teaching them endodontics.

“Fred rallies the residents as mentors and instructors in the preclinical labs,” Dr. Tordik explains. “They do a great job…he teaches them not to laugh at the students and to be kind and helpful and give constructive criticism. It ends up being a very positive experience for everyone.   He’s very friendly but very strict about the standards and hasn’t lowered them but at the same time gives opportunities to succeed and meet the standards.  Not all of them get it the first time around.  But he keeps the door open to help them improve and get better so they’re ready to see pts in the clinic.”   

“He’s very good at connecting and building relationships ..” Rollor says. “He doesn’t just focus on the school part. He would come out with us and if there was ever a school event he was there with us, always interacting and making sure we had a good experience in school.  I have to push myself to be like him.”

“When I started residency I didn’t know which mentor I wanted to work with.  After just a few months I got the sense that every resident wanted to work with him,” observes Singh.  “Just working with him, the majority of the time is stress-free.  He won’t take any excuses–if you give him nonsense, he’ll smell it and tell you to your face, but if you’re doing your work he’ll treat you like a friend and colleague… And when you’re doing your research, he’s able to do some prospective thinking and put himself in the chair of the people who’ll review it five months from now…. He’s very good at that!” 

Not surprisingly, Dr. Martinho continues to cultivate and develop interest in endo both among dental students who came to school with previous experience and those who had never even considered it. 

 “When I give my lectures, I teach them the basic principles. I want to make sure they understand it,” Martinho explains. “Then right in the middle or toward the end I start introducing what’s going on in the topic and then I show them future directions.  I say this is where we are and what you need to know, but this is where we might be in the future… I want them to see what’s advanced in the fields now.  I usually incorporate some info from the residency program just to expose them to say, this is how we clean in the post-grad …you’re here, and if you do a residency, this is what we do now for cleaning… but look! Here’s where we might be in the future…  

“I think it’s important because maybe you’re going to get some students interested in endo just by showing them…” 

“I came in wanting to do peds only, and I still do, but he really tapped into a passion for endo,” UMD D3 Keyan Bashiri notes. “He just made it sound so cool. I remember our first lecture… it was the idea that we can save these teeth!  I worked in a general office for a little bit and the doctor would almost always revert to doing an extraction as the primary solution.  But Dr. Martinho taught us that you’ve really got to do the full test…that really flipped a switch for me…” 

Abraham came to dental school after four years working in an endo office.  “I was always really Dr.awn to him to grade my work because it wasn’t just about what’s good in lab or what will get you an A or B or C?  He was all about ‘can you do this in the real world? is this clinically acceptable?  Will this give you the best result for your patients?’” Abraham says.   “And because he is so involved in research, he brought up the latest literature. I really valued his opinion of my work.  If you told him you’re interested in endo, he really kind of pushed you toward it!” 

Dr. Martinho’s teaching style also influenced UMD D3 Cesar Hernandez.  

“In one lecture on pulpal inflammation he structured everything in sequence to understand pulpal health from the micro level to the macro level, but he would use research articles in between the slides to support our understanding …” Hernandez explains.  “Just the way he sequenced everything all made sense, it was a domino effect…Coming into dental school I shadowed a GP and wanted to do general dentistry but after his course I fell in love with endo.  I woke up every day excited to be there and be in the lab and now I want do endo!”   

A native of Brazil, Martinho first came to the United States as a high school exchange student.  Knowing that he wanted a career in the health sciences, he followed an older brother into dentistry “and loved it…”  He is quick to point out, however, that dental training is very different in South America.  His first endodontic case in dental school was a molar. 

“Whatever shows up, you have to manage it,” Martinho recalls. “I was freaking out..what am I going to do?!  But then I ended up completing the case in one session, and I thought, ‘Alright I like this…’ The second (time in) clinic was another molar, I managed it .. ‘OK, I think this is what I want…’” 

Graduating from Estacio de Sa University in Rio de Janeiro at the top of his class, he pursued specialty training in endodontics while serving in the Brazilian Navy, but also discovered his own affinity for teaching and a desire to pursue an academic career.   He enrolled in a Master of Science degree program at State University of Campinas Piracicaba Dental School in São Paulo with a dual focus on teaching and research as a student of Professor of Endodontics Dr. Brenda Gomes, whose own positive mentorship forged his identity as an educator, particularly through her knack for engaging students in endodontics.   

“We live endo all the time,” Gomes says. “I do lots of research but I need talk with undergrads to pique their interest because I want to have them with me later on at the masters and doctoral level. It needs to start in the early stages of the undergraduate courses… I talk with them and bring them into the lab..  We help them early on when they have lots of difficulties.  I just try to make endo the best thing…”  

Gomes’s creative openness to new study ideas helped lay the roots for his pursuit of a doctorate with her as his advisor.  

“Usually in most labs people have their research interest — not many PIs are really open if you come as a PhD,” Martinho explains.  “You have to fit into their ongoing project, or they’re not interested in working with you…they look at PhD students as just more hands for their own project…” 

Gomes recollects that Martinho needed some fresh motivation to begin his doctoral studies.   

“Do something different,” she counseled him.   

So Martinho headed back to the US as a visiting scientist in the periodontology lab of Dr. Richard Darveau, where he studied endotoxins and learned the laboratory techniques for lipopolysaccharide (LPS) extraction.  Armed with new technical knowledge he could bring back to Brazil, Martinho immersed himself in LPS analysis and host immune response to LPS, continuing to work in Darveau’s lab during his doctoral studies. His research was recognized as the preeminent doctoral thesis for the year by the Brazilian Ministry of Education. 

Subsequently serving as a full-time assistant professor of endo at São Paulo State University, Martinho cemented his own passion for education while teaching labs, courses and clinic and mentoring masters and doctoral research. 

“Teaching a variety of students with different skill sets and observing them become more proficient, I realized that I was also learning from them,” he reflects.

Also driven to learn a different educational system and continue higher level research, Martinho uprooted his life five years later to join the faculty at University of Maryland—a move Gomes says “was very difficult for me…When he left the lab felt so vacant and empty.. he filled it with so much activity… I always talk about Fred to my students as an example of perseverance.  He was able to motivate himself to complete his PhD. He’s a great example to my students of someone who went further…” 

The change brought Martinho new learning opportunities as an educator along with all the personal challenges of getting re-established in a new continent and culture. 

“It’s hard when you’re in you’re in your mid-30s to turn your whole life upside down by going to a whole new country just to advance yourself personally and professionally,” Tordik asserts. “Coworkers showed a lot of patience. He’s really intelligent and so friendly. I even forget sometimes that he had to go through that…at this point it’s a non-issue. He made the adjustment and he’s here, and that’s that.”

“It’s challenging with the new generation, how you get students engaged and interested in your course,” Martinho believes. “It’s harder to keep them engaged in the ‘classical’ teaching style I grew up with in Brazil.  Instead, I like approaching them one on one and interacting with them during lectures. During a simulation lab, I like interacting to make sure they understand.  And I encourage them to participate in research so they are closer to me.”   

Complementing his primary role as undergraduate endodontic program director, Dr. Martinho’s background has helped chart a course for research that combines microbiology studies with new clinical devices to look at healing outcomes for a range of new technologies.  In doing so, he is preparing the next generations of endodontists to embrace technology which may not be mainstream at the moment, but could be in the future with continued advances in the field.

Catalyzed by the donation of an X-Nav surgical guidance system from a University of Maryland oral surgery alumnus who wondered if the technology originally developed for placing implants could be useful in endodontic surgery, Tordik says Martinho “jumped right in and did it.”  The two Foundation-funded grants which Martinho secured to study a new software application on the platform customized for endodontics were instrumental in securing Federal Dr.ug Administration approval of the device.

“There’s only one way to really progress the field and that’s by testing out different technologies,” Rollor believes. “While things might not be practical now, I think he realizes that for the future, the more research that’s done now, the more you can advance so it’s more feasible later on.  Eventually the technology and cost will change and people will begin doing things in a different way.  The more you work with it, the more proficient you get at it..” 

“I do know a lot of companies are hiring endodontists with implant experience,” Hernandez observes. “If you’re able to use a surgical guidance device for implant surgeries and apicoectomies I feel like you’re a more versatile clinician.  For me, imaging is everything… the comfort and security of being able to look up and know exactly where you’re going …” 

For a career changer like UMD D4 Daniel Syrianos-Robertson, who worked as a mechanical engineer for a decade before coming to dentistry and endodontics, “If there’s one thing he’s taught me it’s that you can’t stop learning,” Syrianos-Robertson says.  “The same thing doesn’t work over and over.  There’s too much knowledge out there and every patient presents different variables…. It’s about staying up to date with technology and diagnoses and training to be better prepared for that variable that surfaces from patient to patient.” 

Nor does the learning stop for Martinho. To re-establish his clinical credentials in the United States, this summer he will begin advanced placement in a postgraduate program in addition to full time teaching and research.  The Foundation Fellowship will make it financially possible for him to advance his own career while continuing to mold the careers of hundreds of general dentists and dozens of endodontic specialists. 

“I’m so grateful I’m going to have the opportunity to get my advanced training so I can be more involved with the residents and specialty,” Martinho says. “I think I can contribute a lot with research and clinical aspects.  There are not that many clinician scientists around.  I think I can add to learning and clinical practice for the entire specialty….” 

For the future, Dr. Martinho sees himself continuing to take on higher academic roles which will position him to have even greater impact on shaping endodontics for generations to come.  The recognition he is already receiving from all who know him certainly portends well for bright horizons ahead. 

“At the end the year they give a teacher of the year award,” Tordik notes.  “It doesn’t go to someone who works with residents. It’s always to the someone who works with the pre-docs because that’s the greatest impact.”   

Martinho hasn’t won that award yet, “but he hasn’t been the director for very long.”